2 PRZEGLĄD TERAPEUTYCZNY NR 1/2006KEY QUESTIONSHow do practitioners assess their competence in the different areas of breastfeeding support?How do practitioners rate the importance of the various areas of breastfeeding support?What are practitioners’ overall experiences of supporting breastfeeding?What is practitioners’ knowledge of policies and guidance on breastfeeding?What professional training have they undertaken/will undertake and how do they rate its helpfulness?How do practitioners rate various approaches to learning?

5 AREAS OF COMPETENCE IN BREASTFEEDING SUPPORT SKILLSPRZEGLĄD TERAPEUTYCZNY NR 1/2006AREAS OF COMPETENCE IN BREASTFEEDING SUPPORT SKILLSMANAGING COMMON CLINICAL PROBLEMS IN EARLYBREASTFEEDING (ex. thrush infection, mastitis, engorgement)75% of respondents find it quite or very importantOver a half of respondents are competent or experts in this areaLess than 10% of respondents are not competent in this areaHELPING MOTHERS WITH OLDER INFANTS (ex. weaning toliquids/solids)70-80% of respondents find it quite or very importantThere are very strong positive associations between self rated competence and ratings of importance of the area for updating

6 TRAINING NEEDS IN BREASTFEEDING SUPPORT SKILLSPRZEGLĄD TERAPEUTYCZNY NR 1/2006TRAINING NEEDS IN BREASTFEEDING SUPPORT SKILLSSKILLS IN ANTENATAL CARE AND COMMUNICATION(ex. formal aspects of antenatal education)70 – 80% of participants find it quite or very importantat least 1 in 4 regarding themselves as not competent, unrelated to whether this is part of their current rolePRACTICE SKILLS REGARDING BREASTFEEDINGSUPPORT (ex. assisting in demand feeding)60 – 70% of participants find it quite or very important1 in 5 participants do not expect to be competentnearly all can see some relevance to being updated about these skills in the next 2 years.SOCIO – CULTURAL ASPECTS OF BREASTFEEDING SUPPORT(ex. working with teenage mothers)80% of respondents find it quite or very important10% believe of they are not competent in regard to these skills while less than a half describe themselves as competent or experts

7 KNOWLEDGE OF POLICIES AND GUIDANCE ON BREASTFEEDING – correct answersPRZEGLĄD TERAPEUTYCZNY NR 1/2006KNOWLEDGE OF POLICIES AND GUIDANCE ON BREASTFEEDING – correct answersWhat is the current national rate of initiation of breastfeeding in EnglandCan you identify the Government target for breastfeeding?What is the youngest age at which current Government guidance suggest solid foods areintroduced?For how long does W.H.O. suggest mothers should exclusively breastfeed their babies ?

8 ORGANIZATIONAL BARRIERS FOR BREASTFEEDING SUPPORTPRZEGLĄD TERAPEUTYCZNY NR 1/2006ORGANIZATIONAL BARRIERS FOR BREASTFEEDING SUPPORTAll respondents experience organizational barriers, and almost 60% of participants experienced atleast two organization barriers.More organizational barriers are related to lower competence level in regard to “provision of information and support” and “socio – cultural aspects”0,00%10,00%20,00%30,00%40,00%50,00%60,00%70,00%1Unhelpful facilitiesStaff do not adhere to guidelines for BFMothers are given conflicting adviceStaff’s level is to low to provide mothers supportUnsupportive cultureIt’s difficult to recommend BF to mothers with other problemsLack of guidance on breastfeedingProblems with keeping up to dateGuidelines on BF are difficult to follow

9 RECOMMENDATIONS FOR NON MEDICAL HEALTHCARE PRACTITIONERSPRZEGLĄD TERAPEUTYCZNY NR 1/2006RECOMMENDATIONS FOR NON MEDICAL HEALTHCARE PRACTITIONERSA systematic approach is required in all healthcare sectors to establishing the training needs to staff. This should include auditing staff experience of BF training, and evaluation of training completed.Staff sampled welcome training in all 26 skill areas, and those already competent are most likely to want more update. This suggests both that training is reaching “the converted”, but also that staff recognize the need for continual up dating. This may be only awareness raising of areas where practical application is not feasible within the current job roleStaff are surprisingly inaccurate in their knowledge of local, national and WHO policy, and this should be addressed by training and updating on sources of guidance at a local level with reference to these key policies.Action at executive level in healthcare and voluntary sector bodies is required to address the organizational barriers to breastfeeding practice. BFI standards will be a relevant tool in addressing these issues.

10 CHARACTERISTICS OF THE SAMPLE Paediatricians (N = 120)PRZEGLĄD TERAPEUTYCZNY NR 1/2006CHARACTERISTICS OF THE SAMPLE Paediatricians (N = 120)Most respondents currently work as general paediatricians (67,5%), 35,8% work as subspeciality paediatriciansOver a half of paediatricians work for Hospital services other than Primary Care servicesMost of the respondents have been a qualified medical practitioner for less than 5 years (over 68,4%).Most of the respondents (60%) spend at least part of their working time working directly with women, their babies and infants.

11 CHARACTERISTICS OF THE SAMPLE Medical doctors (N = 57)PRZEGLĄD TERAPEUTYCZNY NR 1/2006CHARACTERISTICS OF THE SAMPLE Medical doctors (N = 57)Most of the participants (86%) work as General Practitioner, i.e. in primary and community careAlmost 80% of GPs were qualified for more than 10 years88% of the general medical sample spend some time in their working week directly with mothers and infants. However, this more likely to be about 25% of the time (58% of respondents)

12 AREAS OF COMPETENCE IN BREASTFEEDING SUPPORT SKILLS - PaediatriciansPRZEGLĄD TERAPEUTYCZNY NR 1/2006AREAS OF COMPETENCE IN BREASTFEEDING SUPPORT SKILLS - PaediatriciansMANAGEMENT OF SOME FREQUENT CLINICALPROBLEMS (ex. advising about pain management)30-45% of respondents find it quite or very important50-60% of respondents are competent or experts in this areaLess than 10% of respondents are not competent in this areaHELPING MOTHERS WITH OLDER INFANTS (ex. weaningto liquids/solids)About 50% of respondents find it quite or very important40-60% of respondents are competent or experts in this areaOnly about 6% of respondents are not competent in this area

13 AREAS OF COMPETENCE IN BREASTFEEDING SUPPORT SKILLS – Medical doctorsPRZEGLĄD TERAPEUTYCZNY NR 1/2006AREAS OF COMPETENCE IN BREASTFEEDING SUPPORT SKILLS – Medical doctorsPHYSIOLOGY AND MEDICAL CONTRA-INDICATIONS TOBREASTFEEDINGAbout 80% of respondents are competent or experts in those areasLess than 4% of respondents are not competentMANAGEMENT OF SOME FREQUENT CLINICAL PROBLEMS(ex. advising about pain management, trauma to nipples)65-80% of respondents are competent or experts in those areasLess than 5% of respondents are not competent

14 TRAINING NEEDS IN BREASTFEEDING SUPPORT SKILLS - PaediatriciansPRZEGLĄD TERAPEUTYCZNY NR 1/2006TRAINING NEEDS IN BREASTFEEDING SUPPORT SKILLS - PaediatriciansSOCIO-CULTURAL ASPECTS OF BREASTFEEDING (ex.understanding cultural differences in infant feeding)30% of respondents find it quite or very important30% of respondents are not competent in this areaPROVIDING CARE AT THE INITIATION OF BREASTFEEDING(ex. advising about engorgement, breast refusal)About 45% of respondents find it quite or very important% of respondents are not competent in this areaMEDICAL ASPECTS OF BREASTFEEDING (ex.knowledge of medical contra-indications to BF)About 50% of respondents find it quite or very important10 – 30% of respondents are not competent in this area

15 TRAINING NEEDS IN BREASTFEEDING SUPPORT SKILLS – Medical doctorsPRZEGLĄD TERAPEUTYCZNY NR 1/2006TRAINING NEEDS IN BREASTFEEDING SUPPORT SKILLS – Medical doctorsMEDICAL ASPECTS OF BREASTFEEDING (ex. detectingabnormal growth rates, prescribing to breastfeeding mothers)Less than 40% of respondents find it quite or very important11 – 32% of respondents are not competent in this area(This is of concern as doctors’ decisions about apparently small babies/ poor feeders can result in women stopping breastfeeding or moving to mixed formula feeding.)PROVIDING CARE AT INITIATION OF BREASTFEEDING(ex. advising about breast refusal, engorgement)Less than 30% of respondents find it quite or very important10-70% of respondents are not competent in this areaOnly a minority are likely to see these topics as of great importance for update in the next 2 years. Most of the areas of breastfeeding support listed in the questionnaire were rated as very important by not more than a third of doctors.

16 ORGANIZATIONAL BARRIERS FOR BREASTFEEDING SUPPORT - PaediatriciansPRZEGLĄD TERAPEUTYCZNY NR 1/2006ORGANIZATIONAL BARRIERS FOR BREASTFEEDING SUPPORT - PaediatriciansPaediatricians report presence of more organizational barriers to breastfeeding support in their workplace than other doctors0,00%10,00%20,00%30,00%40,00%50,00%60,00%70,00%80,00%1Mothers have other problemsDifficult guidelinesMothers go home too earlyMothers are given conflicting adviceUnhelpful facilitiesLack of guidelinesStaff's different approachToo low staffing levelsStaff do not adhere

17 ORGANIZATIONAL BARRIERS FOR BREASTFEEDING SUPPORT – Medical doctorsPRZEGLĄD TERAPEUTYCZNY NR 1/2006ORGANIZATIONAL BARRIERS FOR BREASTFEEDING SUPPORT – Medical doctorsMedical doctors other than paediatricians are most likely to experience problems related to guidelines0,00%10,00%20,00%30,00%40,00%50,00%60,00%70,00%1Staff don not adhereStaff's different approachesLack of guidelinesMothers go home too earlyMothers are given conflicting adviceDifficult guidelinesToo low staffing levelMothers have other problemsUnhelpful facilities

18 KNOWLEDGE OF POLICIES AND GUIDANCE ON BREASTFEEDING – correct answersPRZEGLĄD TERAPEUTYCZNY NR 1/2006KNOWLEDGE OF POLICIES AND GUIDANCE ON BREASTFEEDING – correct answersPaediatricians have higher level of knowledge of policies and guidance on breastfeeding than other doctorsThe greater knowledge of policies and guidance on breastfeeding is positively correlated with higher level of competence in skill areasBoth samples of doctors are less aware of policies and guidance than midwives, health visitors and other non medical supporters/ counselors

19 RECOMMENDATIONS FOR PAEDIATRICIANSPRZEGLĄD TERAPEUTYCZNY NR 1/2006RECOMMENDATIONS FOR PAEDIATRICIANSA systematic approach is required in all healthcare sectors to establishing the training needs to staff. This should include auditing staff experience of infant nutrition and BF training, and evaluation of training completed.Senior paediatric staff are surprisingly inaccurate in their knowledge of local, national and WHO policy, and this should be addressed by training and updating on sources of guidance at a local level with reference to these key policies.Action at executive level in trusts is required to address the organizational barriers to breastfeeding practice. BFI standards will be a relevant tool in addressing these issues.

20 RECOMMENDATIONS FOR DOCTORSPRZEGLĄD TERAPEUTYCZNY NR 1/2006RECOMMENDATIONS FOR DOCTORSA systematic approach is required in all healthcare sectors to establishing the training needs to staff. This should include auditing staff experience of infant nutrition and BF training, and evaluation of training completed. This is a responsibility that resides within the GP practice, but PCTs health services that contract general practice services have a duty to ensure independent practitioners are undertaking appropriate training, and a mechanism exists within the appraisal and contracting processes for raising these issues.General Medical practitioners and paediatricians are surprisingly inaccurate in their knowledge of local, national and WHO policy, and this should be addressed by training and updating on sources of guidance at a local level with reference to these key policies. Access to guidelines was a particular problem for this group, and this should addressed via the PCT.Action at executive level in trusts is required to address the organizational barriers to breastfeeding practice. BFI standards will be a relevant tool in addressing these issues. Individual practices can apply for BFI accreditation, although there would be more gain if approached alongside other community and hospital services in their locality.